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General NPI Number Information
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NPI Number | 1285034157
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Entity Type | Organization
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Legal Business Name | CHAMPAIGN-URBANA HEALTHCARE LLC
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Dates
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Enumeration Date | 08/28/2014
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Last Update Date | 08/28/2014
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Provider Practice Location Address
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Address Line | 631 E GREEN ST
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City | CHAMPAIGN
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State | IL
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Zip | 61820-5701
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Country | US
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Telephone | 217-344-9909
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Fax | 217-903-3941
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Provider Business Mailing Address
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Address Line | 631 E GREEN ST
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City | CHAMPAIGN
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State | IL
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Zip | 61820-5701
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Country | US
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Telephone | 217-344-9909
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Fax | 217-903-3941
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | CANDY DIXON
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Credential |
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Telephone | 217-344-9909
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number | 03606913
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License Number State | IL
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